The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juana Mariana Gonzales. The data includes immunizations provided by the practice.

The vendor also enters:

• Two vaccines administered at other sites

   o an influenza vaccine given at a local pharmacy

   o an inactivated polio vaccine given elsewhere and not reported to the registry – the history includes an adverse reaction (febrile seizure) 8 hours after the vaccine was administered

• Adverse reaction to inactivated polio vaccine (febrile seizure) and the date and source of information

• Allergy to egg albumin administered at this site (the registry has different CVX date and lot number information for this vaccine)

NOTE: the historical vaccines will be imported during the Registry query  (e.g. from another practice)

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.

No PreCondition

The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions  in the record created for Juana Mariana Gonzales using the test data provided.

No Test Objectives

No evaluation criteria

No Note

The EHR vendor loads demographic data for Juana Mariana Gonzales.

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

No PreCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juana Mariana Gonzales.

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

• Patient ID (previously listed as “Medicaid Number”) - Vendor supplied [Y]
• Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics [Y]
• Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied [Y]
• Patient Name: First - Juana [Y]
• Patient Name: Middle - Mariana [Y]
• Patient Date of Birth - 12/23/2009  [Y]
• Birth Time - 11:05 [N]
• Patient Gender (Administrative Sex) - F [Y]
• Patient Multiple Birth Indicator - No [Y]
• Patient Birth Order -  NA [C]
• Responsible Person Name: First - Joanna [Y]
• Responsible Person Name: Middle - Merida [Y]
• Responsible Person Name: Last - Gonzales [Y]
• Responsible Person Name: Relationship to Patient - Grandmother (or Grandparent) [Y]
• Mother’s Name: First - Maria [Y]
• Mother’s Name: Middle -Merida [Y]
• Mother’s Name: Last - Gonzales [Y]
• Mother’s Name: Maiden Last - Acosta [Y]
• Patient Address: Street - 4345 Standish Way [Y]
• Patient Address: City - Stamford [Y]
• Patient Address: State - CT [Y]
• Patient Address: Country - US [Y]
• Patient Address: Zipcode - 06903 [Y]
• Patient Address: County of Residence - Fairfield [N]
• Race - Other [Y]
• Ethnicity - Hispanic or Latino [Y]
• Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901  [Y - birthing facility name, not address]
• Patient Birth State - CT [Y]
• Patient Primary Language - English [Y]
• Patient Telephone Number - (203) 555-1212 [Y]
• Patient Telephone Number Type (e.g., home, cell) - home [Y]
• Patient E-mail Address - jmg@gmail.com [N]
• Publicity Code  [N]
• Protection Indicator [N]
• Protection Indicator Effective Date [N]
• Immunization Registry Status [N]
• Preferred Contact Method - Phone  [Y]

No Note

The EHR vendor loads immunization history data from the local practice for Juana Mariana Gonzales.

No Comments

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

The immunization history  the known to the local practice is loaded into the record created for Juana Mariana Gonzales.

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]:

No Note

The EHR vendor loads immunization history data from another practice into the record for Juana Mariana Gonzales.

No Comments

The EMR has recorded all of the pediatric demographic  in the record created for Juana Mariana Gonzales.

The immunization history from another practice is loaded into the record created for Juana Mariana Gonzales.

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria: Vendor successfully records all immunization history data from another practice as provided, with all required attributes indicated by [Y]:

No Note

The provider enters immunization data from a pharmacy as reported by the parent for Juana Mariana Gonzales.

No Comments

The EMR has recorded all of the pediatric demographic data  in the record created for Juana Mariana Gonzales.

The immunization history from the pharmacy as reported by the parent is loaded into the record created for Juana Mariana Gonzales.

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria: Vendor successfully records all immunization history data from the pharmacy as provided by the parent with all required attributes indicated by [Y]:

No Note

The provider documents in the EMR the clinical history of an adverse reaction to the polio vaccine.

No Comments

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

The clinical history of the adverse reaction to the Polio vaccine is documented in the the record created for Juana Mariana Gonzales.

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Evaluation Criteria: Vendor successfully records all demographic data provided with all required attributes indicated by [Y]:

No Note

The provider documents in the EMR the clinical history of an allergy to egg albumin.

No Comments

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

The clinical history of the allergy to egg albumin is documented in the record created for Juana Mariana Gonzales

Supporting data for: Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies. 

Evaluation Criteria: Vendor successfully records all clinical allergy data provided with all required attributes indicated by [Y]:

No Note

Juana Mariana Gonzales is selected as the patient and her record is opened in the EMR. 

No Comments

Juana Mariana Gonzales Initial Data Load completed.

Juana Mariana Gonzales is the active working patient in the EMR.

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Tester shall verify that the product can distinguish Juana Mariana Gonzales from similar sounding names using all of the pediatric demographics:

No Note

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

No Comments

Juana Mariana Gonzales Initial Data Load is completed.

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariana Gonzales

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

No Note

The Immunization Registry returns an Evaluated History and Forecast (Z42) to the EMR in response to the query for patient (Juana Mariana Gonzales). The provider reviews the immunization history from the registry and compares to the immunization history in the EMR. The provider reconciles the information from these sources, importing information known only to the registry, retaining information that is more accurately reflected in the local EMR:

No Comments

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. 

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them.  The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient’s local immunization history and include the time of the update and the source of the new information.

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

No Note